Provider Demographics
NPI:1598789117
Name:DOOLABH, NEELAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:NEELAN
Middle Name:S
Last Name:DOOLABH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:703 S FLEISHEL AVE
Practice Address - Street 2:STE 5000
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2015
Practice Address - Country:US
Practice Address - Phone:903-606-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1185208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752616977107OtherTRICARE E LAKE STREET LOCATION
TX160211202Medicaid
TXK1185OtherMEDICAL LICENSE
TX160211201Medicaid
TX752616977039OtherTRICARE NORTHPARK LOCATION
TX752616977110OtherTRICARE MAPS LOCATION
TX8AM683OtherBCBS
TX8J5071OtherBCBS PROVIDER
TXP00789335Medicare PIN
TX752616977110OtherTRICARE MAPS LOCATION
TX160211202Medicaid
TX8J5071OtherBCBS PROVIDER